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Brenner FIT 2014 – 2015 ANNUAL REPORT

Wake Forest Baptist Medical Center, the region’s only academic medical center, is proud to be home of the country’s most comprehensive pediatric weight management program, Brenner FIT.

Contents

1 Mission, Vision, Goals

3 Highlights of 2014-2015

4 Patient Care

8 Academic Education

9 Research

11 Community Engagement

12 Media

13 Brenner FIT Team

Brenner FIT

2014 – 2015 ANNUAL REPORT

Brenner FIT (Families In Training), established in November 2007, is an interdisciplinary, multi-component pediatric obesity program applying evidence-based approaches to improve the health of children and families. Built on a foundation of research and knowledge gleaned from continued practice, Brenner FIT not only examines the most effective approaches to treatment, but strives to improve quality of care for all families. Brenner FIT has grown to become one of the most successful and comprehensive pediatric obesity programs in the United States. For more information, visit our website.

MissionAt Brenner FIT, we take a comprehensive and transformative approach to pediatric obesity, providing uniquely tailored care to each family, and guiding them toward a lifetime of better health. Through our approach and our passion, we aim to redefine pediatric obesity care, setting new standards in treatment, research, education and community outreach.

VisionWe are driven to provide comprehensive pediatric obesity care that exceeds expectations. Through evidence-based, family-centered care, translational research and experiential education, we will continue to empower families, build community capacity and evoke positive change in child and family health.

GoalsIn the spirit of Wake Forest Baptist Health, Brenner FIT strives to achieve balanced excellence in Patient Care, Research, and Education, as well as Community Engagement.

Brenner FIT Program 3

▶ Received 584 referrals (16% increase) and began treatment of 130 new patients and their families (15% increase). Increased Orientation attendance by 49%

▶ Initiated redesign of Brenner FIT’s clinical treatment, developing additional experiential education components and increasing clinic volume

▶ Expanded TeleFIT, Brenner FIT’s telemedicine program, to Wilkes County, N.C., where the childhood obesity rate is approximately 18%, significantly higher than national percentages

▶ Advocated for nutritious school lunches when Dr. Joseph Skelton, Director, traveled to Washington, DC, to meet with members of Congress

▶ Gave 13 academic presentations with over 600 professionals in attendance

▶ Reached over 1,900 individuals through community education programs

▶ Featured 11 times in regional and national media venues totaling over $900,000 in media value for the medical center and reaching nearly nine million people

▶ Taught approximately 1,100 school children Brenner FIT’s message of healthy living

▶ Participated in 15 community health fairs reaching an estimated 68,000 individuals

Highlights of 2014 – 2015

▶ Offered 91 cooking classes, teaching 1,202 community members about healthy eating

▶ Offered 45 classes focused on physical activity reaching 562 community members

▶ Contributed to academic and medical literature through seven journal publications and five research presentations

▶ Expanded Brenner FITeers, a volunteer program for Brenner FIT families, offering volunteer opportunities with the local Humane Society and the State Employees’ Credit Union Family House

▶ Developed a collaboration with Mary’s House, a ministry providing transitional housing to women recovering from substance abuse in Greensboro, N.C., to donate food to Brenner FIT families struggling with food insecurity

▶ Implemented two Mindfulness-Based Eating Awareness Training series

▶ In partnership with the YMCA and Northwest AHEC, developed and implemented a nine-week summer YMCA day camp cooking series, led by a medical student, that reached over 150 children

▶ Supported two Albert Schweitzer fellows who taught classes in the Brenner FIT kitchen for mothers at risk of child abuse or neglect. Their work demonstrated how families value hands-on learning of basic cooking skills and value trying new recipes

4 2014 – 2015 ANNUAL REPORT

Clinical Activity Brenner FIT has an active clinical program that specializes in providing interdisciplinary (several disciplines focused on the care of each family), multi-component (diverse approaches to treatment including experiential education, classes and one-on-one care), and family-based treatment. The clinical segment is intensive to provide optimal support and to keep families engaged for long-term success. In the first portion of treatment, referred families are invited to attend an Orientation session to gain insight about Brenner FIT treatment. After Orientation, families attend classes and receive phone coach support while they prepare for the subsequent 12-month intensive treatment with their Team.

Referrals for FY15 (Fiscal Year: July 1 to June 30 ) totaled 584 children and teenagers, which is a 16% increase over FY14. The clinical program welcomed 331 new families through the orientation sessions (49% increase) and 130 families completed intake appointments with the Brenner FIT Team (15% increase). Brenner FIT is working to continue expanding capacity to meet the needs of referred families by redesigning the treatment protocol for FY16. The clinical program completed 1,085 family visits this year.

Clinical OutcomesTo our knowledge, Brenner FIT is the only pediatric obesity program in the country to regularly report on outcomes. Brenner FIT’s outcomes are on par with research-focused programs, and we care for high-risk populations, not research subjects: 55% of families receive Medicaid insurance, and the average child has a BMI similar to that of an adult with obesity (BMI 36 kg/m2), but is only 12 years old.

▶ Two-thirds of children improve their weight status in the first four months of treatment, with changes that rival research-based programs.

▶ On average, children dropped their BMI z-score by 0.03 in four months (two-thirds dropped it by nearly 0.1), and by 0.1 at a year. This is comparable to similar clinical programs (Dolinsky DH, Clin Peds 2011; Madsen KA, J Pediatr Endocrinal Metab 2009) as well as research trials (Janicke DM, Archives of Peds Adol Med 2008).

Patient Care

▶ Brenner FIT patients continue to improve their weight status throughout their year of treatment, quite different from traditional diet and exercise programs that have high recidivism rates.

▶ After graduating, most children maintain their new weight status or keep improving.

▶ There are no significant differences in success rates between racial/ethnic groups or the distance they live from Brenner Children’s Hospital.


MSMV (Mejor Salud, Mejor Vida) is the Spanish language part of Brenner FIT

Brenner FIT Clinical Treatment Program Data

Stats on Families in Clinic

FY2013 Based on # attending orientation in FY13



MSMV FY2013 Based on # attending orientation in FY13



Referrals - Total 362 414

14% increase

467

13% increase

85 90

6% increase

117

23% increase

Attending Orientation - Total

155 169

9% increase

265

57% increase

44 53

20% increase

66

25% increase

New Family Intakes - Total

74 87

18% increase

99

14% increase

26 26

No change

31

19% increase

Time from Referral

to Orientation

99.04 days 45.47 days

54% decrease

41.38 days

9% decrease

304.21 days 85.52 days

72% decrease

81.05 days

5% decrease

Time from Orientation

to Intake

51.53 days 65.34 days

27% increase

50.48 days

23% decrease

58.83 days 115.33 days

96% increase

178.65 days

63% increase

Time from Referral

to Intake

150.91 days 110.81 days

27% decrease

101.73 days

8% decrease

363.04 days 200.86 days

45% decrease

259.70 days

29% increase

Still Active (completed intake

and haven’t dropped out)

Data not

recorded

53

60.1% of intakes

67

67.7% of intakes

Data not

recorded

21

80% of intakes

23

74% of intakes



Specialized Clinical Programs Mejor Salud, Mejor Vida (“Better Health, Better Life”) is the highly successful Spanish-language program of Brenner FIT. MSMV provides clinical treatment of obesity to families in their native language. Brenner FIT provides additional support to MSMV families through nutritional assistance, phone support, and other assistance. It is essential that families have access to proper nutrition and supportive, qualified assistance to enable them to focus on health habit changes within Brenner FIT.

In FY 2015, MSMV welcomed 66 families through Orientation sessions (25% increase) and 31 new families completed intake appointments with the Team (19% increase). There were 294 family clinic visits (25% increase) for treatment of obesity. MSMV held a variety of classes for Brenner FIT families: 20 cooking classes, two parenting series, a soccer clinic for teenage boys and four sessions of Beautiful Me, a program for teenage girls. Participation totaled 261 participants. This year birthed an exciting, new partnership with Mary’s House of Greensboro to provide regular food assistance. In just seven months, 175 family members received fresh and frozen food for their home.

TeleFIT is Brenner FIT’s innovative telemedicine program. Telemonitors are located in Brenner satellite clinics, primary care clinics and health departments across western North Carolina and the Piedmont Triad. Active clinic sites include Boone, Lenoir, Elkin,Hickory, Dobson and Greensboro. This program extends Brenner FIT’s proven approach to rural families, providing them with treatment despite geographic and financial barriers. The TeleFIT program expanded to Wilkes County this year, and is looking forward to further expansion in the coming year.

In FY15, the TeleFIT program received 58 referrals, had 23 families attend Orientation, and had 17 families complete initial intake visits. These numbers remain similar to FY14 data. The expansion for FY16 is an effort to better serve more rural families.

Brenner FIT Academy is a new concept that Brenner FIT has designed to offer team expertise in a less-intensive format. Planning to increase access to treatment services, this treatment program requires less staff time and less family time. It is a six-month curriculum with phone coach support designed for families with children ages 2 –18 who have concerns about a child’s weight and health. The first pilot of Brenner FIT Academy is being offered in the community of Thomasville in the Fall of 2015 in partnership with the Thomasville Rotary Club and Thomasville Pediatrics.

Quality Improvement ActivitiesBrenner FIT pays close attention to quality improvement methods for better care and outcomes in pediatric obesity treatment. In FY 2015, Brenner FIT –

▶ Began a redesign effort for our clinical program aimed at enhancing treatment outcomes, increasing adherence, and improving efficacy.

▶ Expanded TeleFIT, Brenner FIT’s telemedicine program, to Wilkes County in an effort to reach rural families who do not otherwise have access to comprehensive pediatric obesity treatment. New site accepting patients in Fall 2015.

▶ Routinely surveyed cooking and parenting class participants to identify areas of interest for future experiential programs and to better meet the needs of patients, their families, and the community.


Academic Education

Educational and Student PresentationsBrenner FIT gives a multidisciplinary presentation to third- year medical students quarterly. Presentations were also given to many undergraduate classes in our area. In total, eight professional presentations were given to approximately 250 students.

Academic Presentations

Brenner FIT gave five academic presentations to approximately 520 professionals.

Regional

▶ Katie Maxey, RD, LDN, and Dara Garner-Edwards, MSW, LCSW, presented at the Trivette Symposium in Hickory, N.C.

National/International

▶ Dr. Skelton was invited as guest faculty to Virginia Tech to speak to the Department of Human Nutrition at the Foods and Exercise Seminar Series

▶ Dr. Skelton presented to the Children’s Hospital of Wisconsin, Medical College of Wisconsin, Department of Pediatrics (Gastroenterology, Hepatology and Nutrition)

▶ Dr. Skelton was guest faculty, 5th Conference on Recent Advances in the Prevention and Management of Childhood Obesity, Winnipeg, Manitoba, Canada (two presentations)

Educational PublicationsDr. Skelton and Ms. Megan Irby published numerous research articles, and Drs. Gail Cohen and Skelton had a book chapter published in the leading textbook for Pediatric Gastroenterology and Nutrition.

As part of an academic medical center, Brenner FIT is dedicated to educating the next generation of health care professionals. In total, Brenner FIT conducted 13 educational presentations to over 610 individuals.

Mentorships, Internships and PreceptorshipsBrenner FIT is committed to educating and training both current and future leaders in the treatment of childhood obesity. In addition to the following students and trainees that worked with Brenner FIT in FY2015, numerous students and trainees shadowed or observed:

▶ Stacy Stolzman, PhDc, Marquette University, Milwaukee, Wisconsin

▶ Thomas Curly, Wake Forest School of Medicine Student Summer Research Program

▶ Joshua Pathman, Wake Forest School of Medicine Summer Intern

▶ Madeline Crego, Wake Forest University Health & Exercise Science Intern

▶ Summer Stanfield, Wake Forest University Healthy Policy Intern

▶ Jason Pearson, Lenoir-Rhyne University Dietetic Intern

▶ Amanda Andraos, Lenoir-Rhyne University Intern

▶ Catherine Brake, Appalachian State University Health Promotions Intern

▶ Matthew Crumpton, Elon University Public Health Sciences Intern

▶ Two Pediatric Residents from Brenner Children’s Hospital spent elective months in Brenner FIT


Research

During FY2015, Brenner FIT continued to grow and mature. Research efforts of note are:

▶ Outcomes of Pediatric Obesity Treatment: The Brenner FIT Clinical Database: This longitudinal tracking system tracks patient outcomes over the course of their participation in Brenner FIT, and provides vital information indicating improvement in children’s health outcomes. To date, this has resulted in six journal publications.

▶ FACT 2: Families And Clinicians in the Treatment of Weight is an observational study of attrition from weight management. Enrollment is complete and data under analysis.

▶ Pediatric Patients’ Perception of the Use of Motivational Interviewing as a Communication Tool for Childhood Obesity Treatment: This collaborative study with East Tennessee State University captured children’s perception of the use of motivational interviewing in obesity treatment.

▶ Parent-Child Discussions about Health Habits: This collaborative study with Virginia Tech investigated parent-child discussions about health habits.

Publications

1 Brown CL, Irby MB, Houle T, Skelton JA. Successfully Treating Obesity in Children with Physical and Cognitive Disabilities. Academic Pediatrics 2015;15:197-203

2 Giannini C, Irby MB, Skelton JA. Caregiver Expectations of Family-Based Pediatric Obesity Treatment. American Journal of Health Behavior 2015;39(4):451-460

3 Stolzman S, Callahan A, Irby MB, Skelton JA. Pes planus and paediatric obesity: a systematic review of the literature. Clinical Pediatrics 2015 epublished ahead of print

4 Bishop J, Irby MB, Skelton JA. Family Perceptions of a Family-Based Pediatric Obesity Treatment Program. ICAN: Infant, Child, & Adolescent Nutrition 2015;7:278-286

5 Brown CL, Halvorson EE, Cohen G, Lazorick S, Skelton JA. Addressing Childhood Obesity: Opportunities for Prevention. Pediatric Clinics of North America 2015 IN PRESS

6 Armstrong S, Lazorick S, Hampl S, Skelton JA, Wood C, Collier D, Perrin EM. Physical exam findings among obese children and adolescents:

State of the art review. Pediatrics 2015 IN PRESS

7 Halvorson EE, Ervin S, Skelton JA, Russell TB, Spangler J. Association of Obesity and Pediatric Venous Thromboembolism. Hospital Pediatrics 2015 IN PRESS

Research Abstracts and Presentations

1 Stolzmans S, Speltz J, Hoffmeister K, Danduran M, Skelton J, Papanek P, Harkins A, Hoeger Bement, M. The Role of Aerobic Physical Fitness on Overweight Adolescents. Obesity Week 2014, Boston, MA, 2014.

2 Halvorson EE, Peters TR, Skelton JA, Suerken CK, Snively BM, Poehling KA. Is weight associated with severity of acute respiratory illness in children? Pediatric Academic Societies Annual Meeting, San Diego, CA. 2015

3 Martin S, Irby MB, Skelton JA. Child and Parent Experience in a Family-Based Weight Management Program: A Qualitative Study of Satisfaction. Pediatric Academic Societies Annual Meeting, San Diego, CA. 2015

4 Skinner AC, Skelton JA, Steiner MJ, Perrin EM. Staggering Rates of High C-Reactive Protein in Severely Obese Children and Adolescents Using Nationally Representative Data. Pediatric Academic Societies Annual Meeting, San Diego, CA. 2015

5 Skinner AC, Skelton JA, Steiner MJ, Perrin EM. Cardiometabolic Risks are High in a Nationally Representative Group of Children with Severe Obesity. Pediatric Academic Societies Annual Meeting, San Diego, CA. 2015

Journal Reviewers

Drs. Skelton and Cohen, and Ms. Irby serve as research manuscript reviewers for several academic journals.

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October 2015 40. Barlow SE, Ohlemeyer CL. Parent reasons for nonreturn to a pediatric weight management program. Clin Pediatr (Phila). 2006;45:355-360.

41. Hampl S, Demeule M, Eneli I, et al. Parent perspectives on attrition from tertiary care pediatric weight management programs. Clin Pediatr (Phila). 2013;52:513-519. 42. Sallinen Gaffka BJ, Frank M, Hampl S, Santos M, Rhodes ET. Parents and pediatric

weight management attrition: experiences and recommendations. Child Obes. 2013;9:409-417. 43. Hampl S, Paves H, Laubscher K, Eneli I. Patient engagement and attrition in pediatric obesity clinics and programs: results and recommendations. Pediatrics. 2011;128(suppl 2): S59-S64.

44. Giannini CG, Irby MB, Skelton JA. Caregiver expectations of family-based

pediatric obesity treatment. Am J Health Behav. 2015;39:451-460. 45. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.

46. Skelton JA, Irby M, Geiger AM. A systematic review of satisfaction and pediatric obesity treatment: new avenues for addressing attrition. J Healthc Qual. 2014;36(4):5-22.

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ICAN: Infant, Child, & Adolescent Nutritiondisclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr Skelton was supported in part through an NIH Mentored Patient-Oriented Research Career Development Award (K23 HD061597). Ms Bishop was supported by an NIH Short-Term Training for Medical Students Award (T35 DK007400; PI: Reid).

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2. Whitlock EP, O’Connor EA, Williams SB, Beil TL, Lutz KW. Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF. Pediatrics. 2010;125:e396-e418. 3. Oude Luttikhuis H, Baur L, Jansen H, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev. 2009;(1):CD001872.

4. Barlow SE. Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(suppl 4):S164-S192. 5. Spear BA, Barlow SE, Ervin C, et al. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics. 2007;120(suppl 4):S254-S288.

6. Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA. 1990;264:2519-2523. 7. Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol. 1994;13:373-383.

8. Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res. 2004;12:357-361. 9. Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev. 2004;62:39-50.

10. Golan M, Kaufman V, Shahar DR. Childhood obesity treatment: targeting parents exclusively vs. parents and children. Br J Nutr. 2006;95:1008-1015. 11. Wrotniak BH, Epstein LH, Paluch RA, Roemmich JN. Parent weight change as a predictor of child weight change in family-based behavioral obesity treatment. Arch Pediatr Adolesc Med. 2004;158: 342-347.

12. Janicke DM, Sallinen BJ, Perri MG, et al. Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project STORY. Arch Pediatr Adolesc Med. 2008;162:1119-1125. 13. Brownell KD, Kelman JH, Stunkard AJ. Treatment of obese children with and without their mothers: changes in weight and blood pressure. Pediatrics. 1983;71:515-523.

14. Nowicka P, Flodmark CE. Family in pediatric obesity management: a literature review. Int J Pediatr Obes. 2008;3:44-50. 15. Nowicka P, Flodmark CE. Family therapy as a model for treating childhood obesity: useful tools for clinicians. Clin Child Psychol Psychiatry. 2011;16:129-145.

16. Nowicka P, Savoye M, Fisher PA. Which psychological method is most effective for group treatment? Int J Pediatr Obes. 2011;6:70-73. 17. Kitzmann KM, Beech BM. Family-based interventions for pediatric obesity: methodological and conceptual challenges from family psychology. J Fam Psychol. 2006;20:175-189.

18. Freeman E, Fletcher R, Collins CE, Morgan PJ, Burrows T, Callister R. Preventing and treating childhood obesity: time to target fathers. Int J Obes (Lond). 2012;36:12-15. 19. Bishop J, Irby MB, Isom S, Blackwell CS, Vitolins MZ, Skelton JA. Diabetes prevention, weight loss, and social support: program participants’ perceived influence on the health behaviors of their social support system. Fam Community Health. 2013;36:158-171.

20. Schor EL; American Academy of Pediatrics Task Force on the Family. Family pediatrics: report of the task force on the family. Pediatrics. 2003;111:1541-1571. 21. Child Trends. Family Structure. Bethesda, MD: Child Trends. http://www.childtrends.org/wp-content/uploads/2015/03/59_Family_Structure.pdf. Accessed July 14, 2011.

22. Holt NL, Moylan BA, Spence JC, Lenk JM, Sehn ZL, Ball GD. Treatment preferences of overweight youth and their parents in Western Canada. Qual Health Res. 2008;18:1206-1219. 23. Taylor SA, Garland BH, Sanchez-Fournier BE, Allen KF, Doak JS, Wiemann CM. A qualitative study of the day-to-day lives of obese Mexican-American adolescent females. Pediatrics. 2013;131:1132-1138.

24. Stewart L, Chapple J, Hughes AR, Poustie V, Reilly JJ. Parents’ journey through treatment for their child’s obesity: a qualitative study. Arch Dis Child. 2008;93:35-39.

25. Stewart L, Chapple J, Hughes AR, Poustie V, Reilly JJ. The use of behavioural change techniques in the treatment of paediatric obesity: qualitative evaluation of parental perspectives on treatment. J Hum Nutr Diet. 2008;21:464-473. 26. Broderick CB. Understanding Family Process: Basics of Family Systems Theory. Newbury Park, CA: Sage; 1993. 27. Irby M, Kaplan S, Garner-Edwards D, Kolbash S, Skelton JA. Motivational interviewing in a family-based pediatric obesity program: a case study. Fam Syst Health. 2010;28:236-246.

28. Irby MB, Boles KA, Jordan C, Skelton JA. TeleFIT: adapting a multidisciplinary, tertiary-care pediatric obesity clinic to rural populations. Telemed J E Health. 2012;18:247-249. 29. Skelton JA, Goff D, Ip E, Beech BM. Attrition in a multidisciplinary pediatric weight management clinic. Child Obes. 2011;7:185-196.

30. Skelton JA, Irby MB, Beech BM, Rhodes SD. Attrition and family participation in obesity treatment programs: clinicians’ perceptions. Acad Pediatr. 2012;12: 420-428. 31. Alasuutari P. An Invitation to Social Research. London, England: Sage; 1998. 32. Willis GB. Cognitive Interviewing: A “How To” Guide. Research Triangle Park, NC: Research Triangle Institute; 1999. http://www.hkr.se/pagefiles/35002/gordonwillis.pdf. Accessed October 19, 2014.

33. Willis GB, Royston P, Bercini D. The use of verbal report methods in the development and testing of survey questionnaires. Appl Cogn Psychol. 1991;5:251-267. 34. Bernard HR, Ryan GW. Analyzing Qualitative Data: Systematic Approaches. Thousand Oaks, CA: Sage; 2010. 35. Charmaz K. Constructing Grounded Theory. Thousand Oaks, CA: Sage; 2006. 36. Skelton JA, Beech BM. Attrition in paediatric weight management: a review of the literature and new directions. Obes Rev. 2011;12:e273-e281.

37. Bowen M. Family Therapy in Clinical Practice. New York, NY: Aronson; 1978. 38. Kaplan SG, Arnold EM, Irby MB, Boles KA, Skelton JA. Family systems theory and obesity treatment: applications for clinicians. Infant Child Adolesc Nutr. 2014;6:24-29.

39. Cote MP, Byczkowski T, Kotagal U, Kirk S, Zeller M, Daniels S. Service quality and attrition: an examination of a pediatric obesity program. Int J Qual Health Care. 2004;16:165-173.


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October 2015behaviors.38 Furthermore, FST posits that families set membership criteria and establish boundaries and flow of information. While this study did not capture the full complexity of families struggling with weight problems, clinicians may recognize that families are not homogenous, and likely view themselves as families nonetheless. Improving the health of multiple family members may be an additional benefit to families not typically expected in such treatment programs, and deserves further investigation.

Logistical inconveniences were routinely mentioned as a main barrier to participation, particularly regarding attendance of other family members (ie, fathers). These barriers have been seen as contributors to attrition in other studies,29,36,39,40 and future interventions directed at families must account for these logistical concerns. Clinicians must be cognizant of how their clinic hours, travel time, and other family members’ schedules can interact to create insurmountable barriers for families. It may be helpful for clinicians to discuss these issues with families early in treatment, as seen in other studies.41-43 By identifying the logistical issues specific to each family, team members may be able to help families develop solutions and better treatment plans for their needs.Responses from these families suggest that they prefer defining specific roles for themselves. Previous research has identified inaccurate parent expectations of program outcomes30 and roles in treatment44 as contributors to attrition. This task can be difficult regarding weight management, as health behaviors are often a product of several contributors in the family. For instance, a child’s eating behaviors are affected by the individual behaviors of the “bread-winner,” the food purchaser, the food preparer, and the actual food consumer. To minimize feelings of guilt or inefficacy, interventions aimed at altering health behaviors should clearly delineate for all family members their appropriate and realistic roles. Other studies and programs include siblings and other

family members as able43; deliberately assisting families to include or engage other family members could improve outcomes for multiple family members.Families expressed desire to remain autonomous in their treatments, but still have a sense of structure in the program. Although it may be a difficult balance to strike, this finding supports the hypothesis that treatment plans designed for chronic health behaviors should be customized to fit each family’s preferences and needs, consistent with tenets of patient-centered care.45 For example, maintaining autonomy could mean allowing patients and family members to choose which activities they engage in and which foods they try. Increased structure could mean incorporating ways for families to track their activities, conduct specific goal-setting between clinic visits, and develop accountability.The study population had racial/ethnic diversity, including representation of Medicaid recipients. Issues around sociodemographics did not emerge from the interviews, which is surprising given the influence culture would have on family identity and experience. Similarly, major differences in responses did not differ greatly between Medicaid recipients and those with commercially funded insurance. While these differences did not arise in this study, further investigation of culture and background on family dynamics and weight is needed. Regardless of the diversity and complexity of families, they were appreciative of treatment efforts, as was seen in other studies that included evaluation of satisfaction with treatment.46

Limitations to this study include the number of families interviewed (15 active and 8 inactive), although we believe that saturation of responses was reached. Nevertheless, the limited sample size did prevent important influences such socioeconomic factors from being comprehensively assessed. Given that patients and mothers were disproportionately represented, potentially valuable perspectives and insight from other family members were

missing. While the nature of this study was to capture the perceptions of multiple family members, few fathers and siblings were able to be recruited, limiting the reach of this study. In addition, we report these findings from a single-family-based pediatric obesity treatment program. Last, rigorous attempts were made to keep data analysis as objective as possible by using multiple coders with predefined definitions for codes. Nevertheless, we acknowledge that the investigators may have had biases that influenced content analysis.The data from this study have implications for those involved in family-based pediatric obesity treatment programs and suggest avenues for future research. For instance, it could be valuable to compare results from families in different programs with the same family-oriented focus, and to attempt to interview more family members. Future studies may use new strategies to elicit perceptions from other family members and build on our initial findings. Although this study was limited by the number of individuals within a family whose perspectives were obtained, it is among the first of its kind to attempt to elicit these previously unsolicited perceptions and attitudes of various family members, particularly in reference to a family-based approach to treatment. This study provides a foundation on which future studies and clinical efforts can build in hopes of better supporting families through the process of family-based treatment.

AcknowledgmentsThe authors would like to thank Karen Klein, MA, ELS (Biomedical Research Services and Administration, Wake Forest University Health Sciences), for editing this article.

Author NoteThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Skelton has been a consultant for the Nestlé Corporation, which was not involved in any part of this research and did not fund any aspects of the research. The authors


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ICAN: Infant, Child, & Adolescent Nutritionwas often limited by scheduling conflicts. Families also stressed that changing their food choices (food type and quality), and their mealtime eating behaviors (how fast and how much) were particularly challenging.

Reason for Attrition. The 2 main reasons for attrition cited by inactive families were distance to clinic visits and conflicting parental work schedules. Many families reported that driving an hour or more to a clinic visit was simply too time-consuming to maintain. For families who had difficulty finding reliable transportation, this distance became an even greater obstacle. In addition, parents who worked at night and slept during the day found clinic visits particularly difficult to attend.

Family Preferences for Addressing Health Behaviors. Families discussed defining roles and responsibilities, autonomy, and structure as a result of participating in Brenner FIT. Several mothers reported that it was challenging for them to relinquish control over their children’s eating behaviors. Many mothers noted that it was difficult, but very effective, for them to realize that they could buy and prepare healthier foods for their family, but that their children had to choose to eat them. Similarly, many parents expressed profound guilt because their children were overweight, especially if they themselves were also overweight. It was therefore helpful for parents to have specific roles and responsibilities (ie, being the food provider or the food preparer), to make the task of getting their family healthier less overwhelming. Furthermore, children and parents routinely stressed the importance of autonomy in making changes to family eating behaviors. Children reported that they were pleased that the program gave them the tools to eat healthier and be more active (ie, provided them with recipes or fun workout ideas), but they chose what meals they ate or in what activities to participate. No substantial difference was seen in responses, comments, or perceptions between racial/ethnic groups. Last, several

families described a desire for structure in their clinic visits, as well their new routines at home. For instance, some parents expressed a preference for more structured clinic visits, incorporating checklists of previously defined goals to be addressed at each visit. Others wanted suggestions for healthier foods, such as meal plans designed by the registered dietitians.Only 4 fathers and 4 siblings were recruited and interviewed. Siblings noticed that changes in their brother’s or sister’s food and exercise choices also influenced them, such as commenting on the change in their parents’ food purchases at the grocery store. Although there were often barriers to siblings attending clinic visits (i.e. school, extracurricular activities), siblings and other family members reported attending more frequently than the paternal caregiver and if they could not attend, siblings and other family members almost always heard about what happened during clinic visit. Fathers often commented that they wanted to attend more clinic visits, but could not because of their work schedules. They had to rely on their spouses for updates and information on future goals. Interestingly, although they attended clinic visits infrequently, fathers often gave very concrete examples of changes made in their home as a result of the Brenner FIT program (eg, foods eliminated from or reintroduced into their homes).

DiscussionMany patients and parents felt that their involvement in a family-based pediatric obesity treatment program was the impetus for significant positive change within their families, such as efforts to become healthier and an improved sense of unity. They identified logistical inconveniences and the inherent difficulties of changing one’s lifestyle as the 2 major barriers to success. Families also said it was important to define clear roles for themselves, maintain autonomy, and operate in a structured program. Consistent with the bulk of research in this area, few fathers were participants.

Finally, although participants were encouraged to bring as many family members as possible to visits, rarely did any family member other than the mother accompany the child, primarily due to work and scheduling difficulties. As attrition from pediatric obesity treatment is unacceptably high,36 findings from this and other studies aid in understanding this phenomenon and hopefully decreasing dropout by assisting families in navigating treatment clinics and instituting changes within the family.The fact that many patients and parents perceived positive changes in their families from the Brenner FIT program supports the FST perspective that efforts to change by one family member can significantly affect other family members.26 Two core tenets of FST are that elements of the family system are interconnected, and the family is best understood when viewed as a whole. These assumptions are demonstrated in the themes of Family Perceptions, in which families recognize the impact program participation has on the entire family, and Family Preferences for Addressing Health Behaviors, where various family members have a role within the health behaviors of the family system. In particular, several participants commented on the impact program participation has on family unity. Furthermore, the themes of Barriers to Family Participation and Reasons for Attrition map to the FST tenet of the system interacting with the environment via a feedback loop, given that many challenges of participating in treatment are found within the daily lives of the family and in the logistical difficulty of reaching clinic. With this knowledge, future interventions can be designed to include other family members and potentially realize even greater overall positive changes in the family unit (ie, increased family cohesion, increased time spent together exhibiting healthier behaviors). A therapeutic application of FST, Family Systems Therapy,37 can be utilized within clinical settings to navigate challenges families may experience in changing weight-related


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Table 3.

Emergent Themes.

ThemeSubtheme

Representative QuotationFamily Perceptions and Attitudes

Appreciation for Provided Resources

“They’ve helped us with ways to exercise, how to exercise, things to do, keeping it fun. It doesn’t have to be grueling. It doesn’t have to be for an hour. The big difference is in the food—how to make a balanced plate. What an ideal day looks like. How we can add things to recipes we already make to make the meal itself more healthy.” (Mother)Changes in Family Health Behaviors

“We can see improvement in our family ’cause we don’t really eat as much as we used to, like junk food. And me and my brothers and sisters are outside more. We’re going to the YMCA, working out, and swimming.” (Patient)Changes in Family Cohesion

“The program kind of set that foundation of us being more of a family . . . and not being lost in our lives. Just kind of focus on the family . . . I think it has gotten us to eat more together, talk more. I mean it helped the family a whole lot.” (Father)Barriers to Family

ParticipationLogistical Inconveniences “I would have liked to participat in [Brenner FIT-sponsored activities at the YMCA], but realistically, it wasn’t possible because of the time. I work at night.” (Mother)Inherent Difficulties of

Lifestyle Changes“There’s something about food that’s just ingrained. And it’s just hard to let go of things that are very comforting. I think there’s another whole level to it mentally with food. So that’s hard to give up, sometimes our favorite foods are [not healthy]. But we should give ’em up. Or hard to give up sweets, tied in with bad habits. We like to eat after dinner . . . and we miss that.” (Mother)Reason for Attrition Distance “I wish there were more things locally that we could have been more involved in.” (Mother)

Parental Work Schedule “The thing that I didn’t like most was the time schedule . . . like gettin’ off immediately . . . after work and comin’ and pickin’ her up and getting’ her there.” (Mother)Family Preferences for Addressing Health Behaviors

Clear Roles and Responsibilities

“It’s encouraging to me as a mother when they tell me my job is to provide the food. I can’t control what they eat. I can’t make them eat it. That my job is just to provide and then it’s their job to choose what they eat.” (Mother)Autonomy “[My children] like that it’s not rigid and set and they can choose among healthy options. They choose what exercise they want to do.” (Mother)Structure “The only thing I could possibly think of [that would improve Brenner FIT] is maybe if there was . . . a little more structure, like say, “you know this month we’re gonna focus on this. And next month we’re gonna focus on this” or something where you’d already have that plan.” (Mother)


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Study staff underwent training with senior investigators to conduct interviews. Telephone interviews were digitally recorded using USB Blast (Goleta, CA) and digital recorders. On completion of the consent process and demographic questionnaire, study staff alerted participants that the qualitative interview portion would then be recorded.

Data Analysis

Interviews were transcribed verbatim from audio records and entered into Microsoft Word (Microsoft Corporation, Redmond, WA). An inductive thematic process was utilized to analyze responses,34,35 which allowed ideas and themes to emerge from the interviews with participants. To minimize bias, the investigators separately read and re-read interview transcripts to identify potential codes. A common coding system was created, as well as a data dictionary for each code to separately assign agreed-upon codes to relevant text. Initially developed codes were modified as needed and notable quotes from interviews were included. The codes were then compiled to compare broad categories from which to develop and interpret themes. Ongoing comparisons and revisions continued throughout the iterative process and during content analysis. Differences in coding were adjudicated by the senior investigator ( JAS). Reliability and intercoder agreement were not tracked, as we were able to adjudicate discrepant codes quickly through discussion.

Study protocols, interview questions, assent and consent procedures were reviewed and approved by the Wake Forest University Health Sciences Institutional Review Board.

Results

Participant Characteristics

A total of 23 patients participated (64% female, 14.8 ± 2.7 years old). The patients had a mean BMI of 37.8 ± 7.98 kg/m2, mean BMI z score of 2.48 ± 0.379, and a mean BMI percentile above the 99th for age and gender. In total, 52

interviews were collected across the 23 families, encompassing mothers, fathers, and siblings. Of all participants, 50% reported to be white, 32% black, 14% biracial, and 5% Hispanic. Insurance coverage was either Medicaid (59%) or commercial insurance (41%). Eight of the 23 families were dual-parent households, 5 blended families (primarily mother and stepfather in the home), and 10 single-parent households (all single mothers). Of the 4 participating fathers, 2 were from dual-parent households, 1 from a blended household, and 1 from a single-parent household, headed by the mother. There were no significant differences between children and households that were active or inactive in treatment. Additional data collected on individuals interviewed are shown in Table 2.

Emergent Themes

Four themes emerged from the interviews: (a) family perceptions and attitudes toward treatment program, (b) barriers to family participation, (c) reasons for attrition, and (d) family preferences for addressing health behaviors (Table 3). There were no substantial differences noted among responses from active families versus inactive families, and thus the following thematic discussion represents responses from both groups of families.

Family Perceptions and Attitudes Toward Treatment Program. Both parents and

children expressed appreciation for information, tools, and skills provided. For instance, many mothers noted that their involvement in program-sponsored cooking classes gave them practical ways to make healthier meals for their family. Similarly, children routinely reported that advice about diversifying their exercise routines was central to their becoming more active. Changes in family health behaviors encompassed multiple new behaviors adopted by families, including joining the YMCA, eating as a family more often, and cooking more meals together. Changes in family cohesion were a major point of discussion, with participants noting an enhanced sense of unity from their combined focus on becoming healthier as a family.

Barriers to Family Participation. Families noted both logistical inconveniences and inherent difficulties of making lifestyle changes as barriers. The former included scheduling conflicts among the child’s clinic visits, parental work obligations, and siblings’ activities; means of transportation to and from clinic visits; and the time commitment of the clinic visit itself. These issues were the most significant sacrifice associated with the program. When children and parents were asked who attended clinic visits, typically mothers were the sole attendants. Despite the clinicians’ attempts to include all family members in treatment, the attendance of fathers, stepfathers, siblings, and grandparents

Table 2.

Participant Characteristicsa.

Active Inactive

Patients 16 7

Mothers 13 8

Fathers 3 1

Siblings 2 2

Total number of families 15 8

aTwo of the active patients were siblings.

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below). At the end of their clinic visit, all family members present were asked if they would like to participate in an interview.Inactive families: Eligible inactive families were identified via review of patient records. Families were considered inactive if they (a) notified the treatment team that they would no longer attend visits or (b) missed or cancelled a scheduled clinic visit and did not reschedule after having received 2 phone calls and a mailed letter.29 These families were contacted via a mailed letter or email, which explained the study and their participation. Interested families who responded were scheduled to complete a phone interview scheduled at their convenience with

as many willing family members as possible.

Subject Selection Criteria. Inclusion criteria for active patients were children currently enrolled in Brenner FIT and active in treatment for 3 to 6 months. Inclusion criteria for inactive patients were children who had dropped out of Brenner FIT within 1 to 3 months, but were active in the program for at least 3 months before attrition. All caregivers and siblings of active and inactive families were encouraged to participate. Additional inclusion criteria included only English-speaking participants, those 7 years old or older, and those able to provide assent/consent. Exclusion criteria included patients or caregivers unable to provide assent/consent due to mental

or cognitive disabilities, or non-English-speaking individuals.

Data Collection. Semistructured interviews were developed based on FST (see Table 1 for questions), as they would be more informative than close-ended questions and allow new areas of interest to emerge.31 Interview guides were developed via cognitive interviews.32,33 These consisted of mock interviews with volunteer families and treatment providers who then provided feedback on how questions were asked. Guides were modified to ensure clarity and ease of understanding, then modified and adapted as needed during the study. The semistructured nature of the guides allowed for further probing of key topics.

Table 1.

Semistructured Interview Guide, Mapped by Domain, With Sample Items.

Family and Child Experience Tell me how the program has been going. How has this program worked for your family?

How has the program met your expectations? How could Brenner FIT have better prepared your family?

What have you liked best about Brenner FIT? What have you liked the least?

Tell me how your child feels about Brenner FIT.

Family Behavior Changes What has been the easiest part about making changes as a family?

What has been the hardest part about making changes as a family?

During Brenner FIT visits, you often learn new things and set goals to make changes at home. How did you take what you learned in clinic and use it at home? How did your family react to the changes you made? What was difficult about making these changes?

Family Participation Which members of your family have been coming to Brenner FIT? What things have made it difficult for family members to come to visits?

Which family members did not come to clinic visits?

How often did you come to clinic without your child(ren)?

What kind of things got in the way of participating in Brenner FIT?

What could Brenner FIT do to help your family stay involved in the program?

Challenges What sacrifices has your family had to make since starting Brenner FIT?

How has participating in Brenner FIT made things harder for you or your family?

How has this program challenged your family?

Abbreviation: FIT, Brenner Families in Training Program.


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difficult to determine how best to deliver pediatric obesity treatment within all family systems.19 Families are diverse and complex, with single, dual, and blended head-of-household configurations, increasing the potential complexity of family-based treatment. To elucidate what constitutes a “family” and how it functions in this setting, more data are needed regarding families’ perceptions and attitudes toward participation in family-based obesity treatment. Particularly, the perspectives of additional family members, such as fathers and siblings, are missing from the literature. By incorporating feedback from families in treatment programs, which is consistent with the principles of patient-centered care,20 it may be possible to inform family-focused treatment strategies and improve treatment efficacy.

The overall purpose of this study is to better understand families’ perceptions of a family-based, meaning family-inclusive, pediatric obesity treatment program. Specifically, we aim to explore patient and family perceptions and attitudes toward family-based treatment, and preferences for addressing health behaviors in family-based treatment settings. Answers to these questions may inform future interventions for family-based obesity treatment and prevention, and potentially increase the likelihood of successful recruitment, retention, and outcomes.

Materials and Methods

Design

A qualitative interview format was chosen for this study, aiming to capture the perceptions and attitudes of various family members participating in a family-based pediatric obesity treatment program. Qualitative approaches have proven useful in other studies of families and obesity.22-25

Theoretical and Conceptual Framework. Family systems theory (FST),26 which describes a family as a complex, interacting system, was the theoretical foundation for this study. FST provides a framework for understanding and exploring the family under 4 assumptions: (a) elements of

a system are interconnected, (b) the family system is best understood when viewed as a whole, (c) the behavior of the system interacts with its surrounding environment via a feedback loop, and (d) systems are not reality but rather heuristic models for understanding processes. FST can aid the understanding of family correlates of behavioral change, and how change impacts individuals and the family unit.

Brenner FIT (Families In Training) Program. Brenner FIT is a family-based pediatric obesity treatment program that utilizes an evidence- and expert opinion–based approach.4,5 Children ages 2 to 18 years are referred by a physician, typically their primary care provider. Criteria are a body mass index (BMI) ≥95th percentile for age and gender (obesity) with a weight-related comorbidity, such as high cholesterol or hypertension. Brenner FIT focuses on identifying unhealthy habits in families, and then aiding them to modify those habits using self-monitoring, stimulus control, and goal setting. Team members are trained to implement motivational interviewing in their work by a certified Motivational Network of Trainers counselor (MINT; www.motivationalinterviewing.org). These skills allow them to encourage goal setting, address ambivalence to change, and maintain open and empathetic discussions with families. Families are instructed and supported in making behavior changes, appropriately managing negative reactions to those changes, and addressing psychosocial issues that arise.

Brenner FIT’s approach has been previously published.27-30 The 1-year treatment is divided into 3 phases, each lasting 4 months. The initial 2-hour visit consists of meeting with the team (physician, family counselor, dietitian, physical therapist). The team conducts a clinical assessment of the child’s health, family functioning, stressors, parenting practices, and the child’s emotional and behavioral issues; dietary patterns and preferences of the family; activity levels; and overall motivation. All family

members are encouraged, but not required, to attend this initial visit, which establishes a relationship between the family and the clinical team. The first phase of treatment consists of biweekly visits, during which the dietitian, family counselor, and a physical therapist are present. As part of goal setting, families “track” their progress between visits to share subsequently with the team and engage in problem-solving discussions. The second phase focuses on advanced goal setting and problem solving, with monthly visits. The final phase is individualized and focuses on maintaining healthy habits and problem solving for goals to be achieved. Visits with the physician occur every 4 months to review laboratory results, BMI, and overall progress. After 1 year, families can choose either to continue treatment or follow-up with their primary care physician for further weight management.

Interviews. Interviews with members of families active in treatment were conducted in-person after clinic visits. Interviews with each parent and child were conducted separately in a private room. Interviews with family members inactive in treatment were conducted over the phone at their convenience. Each inactive family member was interviewed separately. Interview guides were adapted for children with age-appropriate questions. The average length of interviews was 30 minutes for parents and 10 minutes for patients and siblings.

Participants and Study Sites. A key objective was to obtain feedback from family members no longer in treatment (“inactive” in treatment), as well as those still participating in Brenner FIT (“active” in treatment). We employed the following strategies to recruit these 2 groups:

Active families: Before a family’s regularly scheduled clinic visit, their eligibility for the study was determined using the selection criteria (see “Subject Selection Criteria”


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Clinical Research Reports

Abstract: Objective. To better understand families’ perceptions of a family-inclusive pediatric obesity treatment program. Methods. We sought the perspectives of families actively and inactively enrolled in a family-based pediatric obesity treatment program via semistructured interviews. Responses were analyzed by an inductive thematic approach. Results. Twenty-three families participated. Families reported appreciation for program resources and recognized positive changes in family functioning. Logistical issues were reported as major barriers to participation and the primary reason for dropout. Work was perceived as the main barrier to participation for fathers. Families preferred addressing health behaviors in a structured environment. Siblings recognized changes within the family. Conclusions. Families consistently recognized barriers to participation and observed positive influences on family function. Insights were gained from the perspectives of various family members, suggesting that obesity treatment programs could affect the health of multiple family members.

Keywords: obesity; family; qualitative; perceptions; family-based programs; treatment

Although behavior modification interventions have had some long-term success in achieving and

maintaining healthy weight in children,1,2 we lack irrefutable evidence to effectively address pediatric obesity and its many complications.3 According to the 2007 American Academy of Pediatrics Expert Committee Recommendations

Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity, a family-based approach is recommended in conjunction with behavioral modification for pediatric obesity treatment,4,5 supported by substantial research.1,6-13 However, most prior research has featured the child and only one parent (typically the mother) in dyadic treatment approaches rather than multiple family members or entire family units. Furthermore, what constitutes a “family” in this setting is ill-defined and poorly understood, limiting clinical capacity to systematically implement

pediatric obesity treatments among families.

Nowicka and colleagues have explored similar issues to identify which family therapy approaches should be utilized in treatment.14-16 However, in primary care or multidisciplinary treatment settings, inclusion of members beyond the traditional mother–child dyad is a new

concept. Landmark studies, from early trials by Epstein7 and others17 to more recent parent-only interventions,12 have primarily featured a maternal caregiver. While researchers have highlighted the inclusion of the father,18 few have mentioned the entire family, despite the fact that adults attempting weight change have been shown to find support within close social networks.19 Child well-being is strongly linked to that of the parents’ and family,20 and family-based interventions are therefore poised to target the health of the child. However, given the various family configurations and structure in our current society,21 it is

591209 CANXXX10.1177/1941406415591209Infant, Child, & Adolescent NutritionInfant, Child, & Adolescent Nutritionresearch-articleXXXX

Family Perceptions of a Family-Based Pediatric Obesity Treatment Program

Julie A. Bishop, BA, Megan B. Irby, MS, and Joseph A. Skelton, MD, MS

DOI: 10.1177/1941406415591209. From Wake Forest School of Medicine (JAB), Department of Pediatrics (MBI, JAS) and Department of Epidemiology and Prevention (JAS), Wake Forest School of Medicine, Winston-Salem, North Carolina; Brenner FIT (Families In Training) Program, Brenner Children’s Hospital, Winston-Salem, North Carolina (MBI, JAS). Address correspondence to Joseph A. Skelton, MD, MS, Department of Pediatrics, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157; e-mail: [email protected].

For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.

Copyright © 2015 The Author(s)

“Child well-being is strongly linked to that of the parents and family, and family-based interventions are

therefore poised to target the health of the child.”




Community Engagement

The second year in the Kohl’s Family Collaborative Brenner FIT Kitchen has been tremendously successful. This unprecedented space has afforded Brenner FIT patients, their families and the community at large the opportunity to improve their health through a variety of experiential health education programs.

Vital to Brenner FIT’s efforts to provide experiential community health education is a strong and committed relationship with volunteers. Brenner FIT programs rely upon over 100 hours/month of volunteer time. Brenner FIT has been able to again partner with the Junior League of Winston-Salem to provide volunteer staffing for two cooking classes every month and a self-esteem series for teenage girls. Other essential volunteers include community members, WFU medical students and students from other area universities. The team hosted Brenner FIT’s first Volunteer Appreciation event this year.

Brenner FIT was also able to partner with organizations within Wake Forest Baptist Health to expand the utilization of the Brenner FIT Kitchen space. Employees from Best Health, the Weight Management Center and two Schweitzer Fellows were trained by the Volunteer Coordinator and were able to run classes and programs through the Brenner FIT kitchen for community members.

Through a partnership with Northwest Area Health Education Center (AHEC) of North Carolina, Brenner FIT offered two Mindfulness-Based Eating Awareness Trainings to the community with 17 participants attending the intensive 12-session series of classes.

Brenner FIT again secured a grant from Kohl’s Cares for Kids for FY2015. This grant supports the Kohl’s Family Collaborative, an initiative dedicated to improve the health of families within the Winston-Salem community. The Kohl’s Family Collaborative supports advertising, staffing, and programming for community classes and outreach.

Brenner FIT/Kohl’s Family Collaborative classes focus on developing skills through experiential education in the areas of activity, nutrition and parenting-based programming.

My Balanced PlateVegetables Fruit

Lean Protein Starch/Grains

Low-fat Milk or Sugar-free

Drink

Get your family talking• After this meal, what

would you like to play?

• What made you laugh today?

• If you had three wishes, what would they be?

• Who did you sit next to in school and what did you talk about?

• Tell me something nice you did for a friend today.

• If you could fly anywhere in the world, where would you go and why?

• Describe the most interesting thing you did today.

Eat together as a family at least four times a weekBenefits:

• Family togetherness

• Better nutrition

• Weight management

• School success

• Improved behavior

Kohl’s Family Collaborative

brennerchildrens.org/kohls

These classes are offered in both English and Spanish. FY2015 produced new cooking and parenting classes, as well as expanded programming with Brenner FITeers (Brenner FIT’s patient and family volunteer program). Experiential program participation grew to 1,908 participants in 159 classes.

In total, community outreach efforts during FY2015 reached:

▶ 1,136 people through 34 school and youth presentations

▶ 1,300 people through eight Corporate Wellness events and health fairs

▶ 66,966 people through 17 community presentations and events

▶ Approximately 500 people who attended The Brenner FIT Challenge

▶ 1,202 people who attended 91 cooking classes in the Brenner FIT Kitchen

▶ Over 1,200 volunteer hours

Mejor Salud, Mejor Vida provides community education in the Brenner FIT Way to Spanish-speaking families throughout Forsyth County. Program Manager Angelica Guzman worked closely with community organizations (El Buen Pastor Latino Community Services, Cancer Services, La Comunidad Project), leading 36 community classes on parenting, cooking and self-affirmation topics as well as training Latino Community Services staff in the Positive Discipline approach to parenting. MSMV reached 337 community members with these Spanish-language classes.


Media

Brenner FIT contributed to numerous regional and national media outlets through screen, print and radio formats during FY2015:

▶ Parade Magazine

▶ Piedmont Parent

▶ Salem Chronicle

▶ 1250 AM WHNZ Tampa Bay

▶ FOX 6 Milwaukee

▶ FOX 8

▶ WFMY

▶ WXII

Significant national media presence introduced Brenner FIT’s expertise and lifestyle model to an estimated 8.8 million individuals. The value of 11 separate media events totaled $944,831 in positive advertising via unpaid media and publicity for Brenner FIT and Wake Forest Baptist Medical Center.

Dr. Skelton’s interview on Fox 6 in Milwaukee

Brenner FIT Challenge - Get Fit with Your Family on Fox 8 in Winston-Salem

8.8 millionTotal Reach

$944,831Media Value

11Media Events

▶ Forsyth Humane Society Newsletter

▶ Forsyth Woman

▶ Forsyth Family

▶ YMCA (homepage)

▶ YMCA (newsletter)

▶ Parents Magazine

▶ Quad-Cities Online

▶ Facebook posts


Brenner FIT Team

Joseph Skelton, MD, MS▶ Director Associate Professor of Pediatrics Associate Professor of Epidemiology and Prevention

Dara Garner-Edwards, MSW, LCSW▶ Associate Director, Family Counselor Certified Positive Discipline Parent Educator Advanced training in Feeding Dynamics, Mindfulness-Based Stress Reduction, Mindfulness-Based Eating Awareness (MB-EAT), and Motivational Interviewing

Lorri Busby, MSW▶ Family Support Specialist and Social Worker Advanced training in Mindfulness-Based Stress Reduction and Motivational Interviewing.

Casey Foster, BS▶ Exercise, Activity and Play Specialist; Internship

Coordinator Certified Play Facilitator, Advanced training in Motivational Interviewing, ACSM – Certified Personal Trainer

Megan Irby, MS, MS, PhD Student▶ Research Program Manager Advanced training in Motivational Interviewing and family-and parenting-based research methodologies

Christine Jordan, EdS, LMFT▶ Family Counselor; Clinic Coordinator Certified Positive Discipline Parent Educator Advanced training in Feeding Dynamics, Mindfulness- Based Stress Reduction, Mindfulness-Based Eating Awareness (MB-EAT), and Motivational Interviewing

Melissa Moses, MS, RD, LDN▶ Dietitian; Referral Coordinator Advanced training in Mindfulness-Based Stress Reduction and Motivational Interviewing

Gail Cohen, MD▶ Pediatrician Associate Professor of Pediatrics

Melissa Dellinger, RD, LDN▶ Dietitian, Mejor Salud, Mejor Vida (Better Health, Better Life) Advanced training in Motivational Interviewing

Sherry Frino, PT▶ Physical Therapist Advanced training in Motivational Interviewing

Angelica Guzman, BS▶ Program Manager, Mejor Salud, Mejor Vida (Better Health, Better Life) Certified Positive Discipline Parent Educator Advanced training in Feeding Dynamics, Mindfulness- Based Stress Reduction and Motivational Interviewing. Certifications in research ethics and compliance

Katie Maxey, MS, RD, LDN▶ Dietitian; Kohl’s Family Collaborative Coordinator;

Volunteer Coordinator Certified Zumba® and Zumba Kids® Instructor Advanced training in Feeding Dynamics, Mindfulness- Based Stress Reduction, Mindfulness-Based Eating Awareness (MB-EAT), and Motivational Interviewing

Deborah Pratt▶ Administrative Assistant Advanced training in Motivational Interviewing

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Email: [email protected]

Brenner FIT Wake Forest Baptist Medical Center Medical Center Boulevard \ Winston-Salem, NC 27157-1060

336.713.BFIT [email protected] www.brennerchildrens.org/brennerfit

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